Her friends had asked her to stop. The black market injections that Amelia Lopez Zaguilan took to enhance her curves could so easily be tainted. She already had undergone two sessions with the needle, and was on her way to Citrus Heights for a third.

Lopez Zaguilan, 22, was transgender, and the regular hormone shots she received at the Fremont clinic had only gone so far in transforming her appearance. The free-form silicone injections she’d been getting were illegal and unsanctioned – but they promised a womanly figure that hormones alone could not achieve.

So on April 30 last year, Lopez Zaguilan trekked from Oakland to Citrus Heights, where another transgender woman pumped the silicone substance into her buttocks. Within 24 hours, she became short of breath; by the next afternoon, she had slipped into a coma. She died at Mercy San Juan Medical Center a week later, on May 7.

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By the time police were notified of the death, Alejandra Mendoza, 37, the woman who allegedly provided the injections, had vacated her Citrus Heights apartment and could not be found. Citrus Heights police have obtained a warrant for her arrest on suspicion of murder and are asking for the public’s help in tracking her down.

As the search continues, medical professionals and Lopez Zaguilan’s friends are hoping her story will spread awareness about the world of “pumping” – an underground avenue to illicit silicone injections sought to enhance and soften features such as cheeks, breasts and hips. Advocates say the practice is rampant in the transgender community, despite the deadly potential.

“This is a huge public health crisis,” said Danielle Castro, a community mobilization specialist at UC San Francisco’s Center of Excellence for Transgender Health. “It’s very prevalent and readily available.”

Castro also works as an intern therapist at San Francisco’s Dimensions Clinic, which offers health services for transgender people. She said it’s common knowledge in the community that finding a so-called “pumper” is as easy as a few phone calls. “I could have it done this weekend if I wanted to,” she said.

Pumping, in theory, is the injection of free-form silicone for wrinkle-filling and other augmentation. Unlike silicone implants encased in bags, free-form silicone is not approved by the federal Food and Drug Administration.

The injections can provide immediate satisfaction in terms of self-image. But medical experts say the procedure carries risks. Sudden death is rare, but longer term consequences are common. If silicone gets into a vein, it can move to the lungs and cause pulmonary embolism, a potentially fatal blockage. The use of needles poses the risk of infection. Most commonly, the silicone hardens, takes on a new shape or migrates.

“You get an injection in the buttocks and it ends up in your ankles,” said Dr. Nick Gordon, a Davis emergency physician who volunteers at San Francisco’s Lyon-Martin Health Services clinic. “It can be disfiguring.”

In addition, pumpers have been known to use a range of cheap substitutes, from aircraft lubricant to caulking, that can have toxic effects. In one Florida case, a woman went to the hospital after being pumped with Fix-A-Flat, a sealant for car tires.

“It’s mostly (junk) you buy at the hardware store,” said Woods, who is the transgender program services manager at the Tri-City Health Center in Alameda County.

Advocates say the risks of pumping aren’t well understood by some people in the transgender community. Others find false comfort in a pumper’s claims of medical training in another country. And the practice is common enough that many people know someone in the community who has pumped without problems, which encourages the use.

“I never heard of nobody dying because of silicone. All the girls – they were doing it,” said Cinthya Herrera, a close friend of Lopez Zaguilan who does transgender outreach for the Tri-City Health Center. Herrera estimates she was pumped eight times before Lopez Zaguilan’s death. “I didn’t think it was risky.”

Plastic surgery can accomplish many of the same objectives, advocates say, but is also more expensive – running thousands of dollars compared to $150 or $200 for a pumper’s syringe. Some insurance companies label such augmentation as “elective” and “not medically necessary,” and thus not covered.

Advocates say the lure of augmentation is about more than vanity. They describe a desire to “live authentically,” with a body that reflects one’s gender identity. Another factor is more instinctive: wanting to live safely.

“The more you look like a woman, the less likely you’ll be seen as a man in a dress,” Woods said. “If you can’t be detectable as having a gender history as a male ... it helps you navigate society much more safely with much less violence.”

Born in Mexico, Lopez Zaguilan went to high school in the Las Vegas area and moved to Oakland with her mother several years ago, Herrera said. She began dressing as a woman in Nevada, but did not start taking hormones until after Herrera befriended her and invited her to the clinic.

Herrera said that, like many transgender women who seek silicone injections, Lopez Zaguilan wanted more than what the hormones could give her. She wanted curves.

Herrera said Lopez Zaguilan went for her first injection several months before her death. She wasn’t happy with the results, so saved up money for a second injection a few months later, Herrera said. She scheduled that appointment with Mendoza, and left ecstatic. She made another appointment with Mendoza less than a week later, her friends said, despite Woods’ protests.

The last appointment took place April 30, police said, in Mendoza’s apartment in the 5800 block of Sunrise Vista Avenue.

The exact cause of death remains unknown, pending test results, according to the Sacramento County Coroner’s Office. However, Citrus Heights police are investigating the case as a homicide and say they believe Lopez Zaguilan died as the direct result of “unlicensed cosmetic surgery procedures” she received from the suspect.

The warrant issued for Mendoza’s arrest uses her birth name, Sidronio Mendoza-Aguilera. Police described her as Hispanic, 5 feet 6 inches tall, weighing 104 pounds with blond hair and brown eyes. She has “distinct tattooing” on her right shoulder, police said.

Mendoza does not have a license to practice medicine in California, and, in addition to murder, faces a felony charge related to that allegation, according to police and court documents.

Woods said she knows of two other clients at her clinic who say they were pumped by Mendoza, and that neither has experienced serious health problems. Efforts by The Sacramento Bee to find Mendoza or her relatives were not successful.

At the Tri-City Health Center where Woods works, Lopez Zaguilan’s smiling face has been added to the clinic’s memorial wall, a tribute to the many people in the community who have died from violence or AIDS.

Woods remembers a beautiful young woman who knew little English but communicated through hugs and kisses and a warm “gracias” at the end of every visit.

“She was just a kid,” Woods said. “She was a kid with her whole future ahead of her, and she was just blossoming in her transition.”

Last week, Woods chatted with a client who had just gotten a nose job – but told staff members she drew the line at getting pumped. “I don’t want to die like Amelia,” Woods recalled her saying. Woods hopes others will carry that lesson with them.

“Amelia’s death made an impact on her,” Woods said. “We can change some lives with this.”

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